014 (2)
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2009-10-'16 JCM
TOWN OFWAPPING'ER
Application for Public Access to Records
FOIL REOUEST
FOR .INTERNAL USE ONLY
Received by:
Chris MnsterliOJl 0
Christine Fulton if
Sue Rose 0
o d. 1 0;; 1 a!2!..-O
1'-/
Date Received:
FOIL SeL #:
I>EP ARTMENT1
ASSESSOR
ACCOUNTING
DE ENFORCEMENT
, ANNING
ZONING
FIRE INSPECTOR
illGHWAY 0
RECENER Of' TAXES 0
RECREATION .D
SUPERVISOR 0
TOWN CLERK '0
W ATERISEWER 0
DOG CONTROL OFFICER 'YA
TOWN ENGINEER '0
TOWN A ITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dap! tJli ~ ~
Department Head 'approval:
- ~init)
2-1 ~ /rJ
Date FOIL fulfilled or denied: _I _ 1 c:a
AD
1L 1 t2!f 12
Date Applicant Contacted:
Closed 'by:
. Date:
. 'Notes:
AmountDue: _ PagesfQl' .a toml of.$
4,
Name:
Address:
'1... GIll ES,lfJ1E 8. ASSOC'~ y4heckh~J'e'ifYOU are
CONSUl ilNG ENGINEERING pl..UlreqLle~ttng that :the records
f\47 Route 376 be mailed to thiS address.
. 'lis, N't 12590 , I J_ .
~. . FAX#: ~.t;j~~~
Agenc)' or firm:
Telephone 41; ~
EmaiJ address: .
SPBCIFlC DESCRIPTION OF RECORD:
~ ~~::r~~~~~ r~~~t~~ ~: ~t.ta~~i~9 v~o1a;~~~;. buildi~-----
-='-__m____ ___~__s ___ _~.n__ + J nn F; r ' n !':pF!r.t., nn T"PpnT't!': r
bUildin~~ermi t a;Plications, .etc...
Spec:ifj npl'lT"r.P lnr.l'ltpfi l'l~ :P.ORR 'Rm,tp em, Wl'lrrirllJPT' 1i'Qll~. NY
12590. owned by Martin and 'Nancy Brundage. Tax #6057-04-847098
FORMAT OF RECORD (ifnvailable)
o
o
J request to be notified when .1 can come to inspect the record(s) described above
I request copies of the records described above and agree to pay tbe cost of such records in
accordance with the fee schedule on the back ofthis application
] request that the records be sent via e"mail to the addl'csS listed above
] request that the -records be t~\xed to the number listed above
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